ENDOSCOPIC ULTRASOUND GUIDED RADIOFREQUENCY ABLATION OF INSULINOMAS IS SAFE AND EFFECTIVE

Aims:

Insulinomas can produce symptomatic hypoglycemia and life threatening events. Complex surgical procedures with morbidity and occasional mortality are the treatment of choice. We aim to present our experience using a minimally invasive approach with a new, through-the-echoendoscope radiofrequency ablation (RFA) device.

Methods:

We used a Pentax EG-3870UTK linear echoendoscope with a Hitachi Preirus or Noblus Ultrasound console and a 150 cm, 19 gauge needle-electrode (EUSRA- Taewoong medical) with RF delivery in the distal 10 mm, connected to a RF generator (VIVA RF STARmed, Korea) settled to deliver 50w.

Results:

Since March 2017, 8 patients (4 females) were treated; all presented with recurrent hypoglycemic events. Median age was 58 (IQR 42.2 – 65). Seven patients refused surgery and one was referred after a failed surgical attempt. Lesions were located in the uncinate process, head, body and tail in 3, 2, 2, and 1 patient respectively. The median lesion size was 16 mm (IQR 13.37 – 17.25). The tumor was completely ablated in 7 of the 8 patients during a single session with a median of 6 (IQR 2.75 – 7.25) RF applications (impedance 100 – 130 Ohms) during 5 – 12 seconds. No severe adverse events occurred. After a median follow up of 9.25 (range 1.5 – 21) months, all patients had excellent clinical response, judged by normalization of glycaemia, by their ability to return to a normal diet and by the absence of symptoms during overnight fast. None of the patients required additional treatment.

Conclusions:

EUS-guided RFA is feasible, safe and effective for the treatment of insulinomas. It represents a promising, less invasive and more cost-effective alternative to surgery.